Elizabeth, “Betty” Howard, 83, of Richland, Wash., died of heart failure in a rehabilitation facility today, after a nearly five-month long battle with E. coli. She is the fourth to die from an outbreak that killed three this fall.

Bags of spinach in June Dunning’s refrigerator tested positive for the bacteria. The 86-year-old of Hagerstown, Md., died Sept. 13. The outbreak was traced to pre-washed, bagged spinach from processor Natural Selection Foods of San Juan Bautista, Calif., sold by Dole. It sickened 199 people in 26 states, according to the Food and Drug Administration.

By Elizabeth Weise, USA TODAY

The E. coli outbreak that swept the country this fall, killing three people, claimed its fourth victim Friday.

Meanwhile, there was new evidence that a death occurring back in September may have been part of the same tragedy, which could raise the death toll to five.

The latest victim is 83-year-old Elizabeth, “Betty” Howard of Richland, Wash., who died Friday of heart failure in a rehabilitation facility after a nearly five-month long battle with E. coli O157:H7, her son Darryl Howard said.

The other victim was June Dunning, 86, of Hagerstown, Md., who died Sept. 13. She tested positive for E. coli O157:H7 at the hospital, Howard said. But because the Maryland Dept. of Health lost culture samples from her illness, the state was unable to confirm the cause of her illness so she had not been officially included in the death toll.

However, the Centers for Disease Control and Prevention confirmed in a letter to Dunning’s family Thursday that tests on the two bags of spinach in her refrigerator were positive for a closely related, and potentially fatal form of the bacteria, E. Coli 0146:H21.

The letter from Cheryl Bopp at CDC’s division of Foodborne Diseases states that the type of E. coli found in Dunning’s spinach was “indistinguishable” from that found in a sample of spinach from Illinois “which also yielded the outbreak strain of E. coli O157:H7.”

In October Caroline Smith DeWaal, food safety director of the Center for Science in the Public Interest, had sent a public letter to the CDC asking that Dunning be included in the death toll because of the strong circumstances linking her death to the others.

The outbreak was traced to pre-washed, bagged spinach from processor Natural Selection Foods of San Juan Bautista, Calif., sold by Dole. It sickened 199 people in 26 states, according to the Food and Drug Administration.

Howard became ill after eating a turkey sandwich with spinach on it. She had been living independently in her own home until she became ill with the O157:H7 strain of the virus. She went into the hospital on Sept. 7 several days after eating the sandwich and never returned home.

“E. coli is like running the blood through razor blades. It devastates every part of the body,” her son said. He said his mother worked for years as a secretary at the Dept. of Energy’s Hanford (Wash.) Nuclear site.

Howard’s medical bills in the rehabilitation center where she died were paid for by the Dole company’s insurer, her lawyer, William Marler said.

Dunning became ill after eating spinach salad on Aug. 28 of last year. On Sept. 2 she was hit with “horrible, bloody diarrhea,” her son-in-law Warren Swartz said. She went into the hospital and never came home.

On Sept. 6 doctors told the family that they’d gotten results back from the stool sample they’d taken when Dunning first entered the hospital and that she had E. coli O157:H7.

“We said ‘What’s that? It sounds like something from Mars,” Swartz said. “The doctor said ‘It’s very rare and in over 30 years of practice I’ve never seen it.’ ” The infectious disease doctor told them that it came from hamburger.

Born in Catford, England, she married an American and moved to the United States after the end of her husband’s 20-year-career in the U.S Army, her son-in-law said.

After her death, Swartz looked up E. coli on the Internet and realized that there was a nationwide outbreak associated with spinach. In their refrigerator Swartz found a half-eaten bag of pre-washed Dole baby spinach with the same use-by date and lot number implicated in the outbreak.

He and his wife Corinne turned the bags over to the Maryland Dept. of Health and Mental Hygiene, which passed them along to the CDC, he said.

Other deaths related to the outbreak include Ruby Trautz, 81, of Omaha, Kyle Allgood, 2, of Chubbuck, Idaho, and Marion Graff, 77, of Manitowoc, Wisc.

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About Bill Marler

Bill Marler is an accomplished personal injury and products liability attorney. He began litigating foodborne illness cases in 1993, when he represented Brianne Kiner, the most seriously injured survivor of the Jack in the Box E. coli O157:H7 outbreak.